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Home My WebLink About2011-01317 - sewer disconnect CITY OF ORONO PERMIT NO.: 2011-01317 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 10/25/2011 952 249-4600 FAX: 952 249-4616 ADDRESS 3645 TOGO RD PIN 17-117-23-31-0034 LEGAL DESC TOWNSITE OF LANGDON PARK LOT 006 BLOCK 010 PERMIT TYPE SEWER PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE DISCONNECTION NOTE: SEWER DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 ZHUK,ELENA STATE SURCHARGE SEWER&WATER 5.00 3645 TOGO RD WAYZATA,MN 55391- TOTAL 55.00 PAID WITH CASH 55.00 OWNER ZHUK,ELENA 3645 TOGO RD WAYZATA,MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the S B ilding Code.This permit may be revoked at any tivaafor due cans AvV=e94ignatuDate Issuedkty Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. �0 City of Orono D�eety�ki <eraiG# 3 /7 P.O.Box 66 ;. 2750 Kelley Parkway ❑Ott':tease SC'I aron`Form(3omtleted ate ' Crystal Bay,MN 55323 t� o$y (952)249-4600pad � a' ? CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- May be subject to further review and may not be issued when the application is received) GEIS fr • .T FORMA T1, { 1. You may apply for utility permits by mail or in person at the City offices. 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will be sent by return mail within 2 business days. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless the permit card is available on the job site. 5. Utility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit does not grant this approval. 7. All work must be done in accordance with State Code requirements. 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. TYPE SIT Check ,' .. at 1 Residential(May Require Approval) ❑ Commercial(Approval Required) ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water e.1fOwner'T foiiria c n Site Address: �' `/ ID 7P—C/ Owner/EGtiq_ 171 ct�4_ Mailing Address: City: Zip: -3,6 Home Phone:6 JC_/ 2- 70 3� 9r Alternate Phone: 16 on� lortnnrl. Contractor: Contact Person: Address: tate License#: City: Zi piration Date: Phone: one: ❑ SAC Charge(2011 Rate=$2,230.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; cast iron ❑Water Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availability Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ �• 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��• . ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pernrit. ■ WATER METERS must be set and sealed by Orono Water Department (952) 2494600, upon completion of meter installation. The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies t t all statements made on this application are,true and correct. Applicant: DAV z 5 2�r1 DATE TIME V/ CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO. 2011 -0131-1 COMPLETED ADDRESS � ✓ TQq-o 12�� OWNER TELEPHONE NO. CONTRACTOR N I Fyy-��.� (61 2-A ff-CR107-0 DESCRIPTION 5QA9W'd—W(34t W(0y1r1 C.C+ ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS ti ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YOU:_YES_NO COMMENTS: CC W cc 0. 0 e a N cc 0 LL W ac Q Z W z W cc d W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE LU W El WORK&PROCEED 7-1ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ElSTOP ORDER POSTED.CALL INSPECTOR 11 CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: Inspector_ White CopylInspector's File Canary Copy/Site Notice